Indiana Management Services Agreement Guide: Fee Rules, Notice Laws and Registration Duties
Indiana's Board rules bar sharing fees except with partners, employees and shareholders and bar paying for referrals, and we found no authority approving percentage management fees.
Key Highlights
- Board rules bar sharing a professional fee unless the person is a partner, employee or shareholder, and bar paying, demanding or receiving compensation for referral of a patient.
- Iterman v. Baker (1938) held a physician may not take diagnostic or treatment direction from a non-practitioner.
- A 90-day attorney general notice applies to certain health care mergers and acquisitions, and we could not confirm whether a management agreement without equity counts.
- The 2026 med spa registration law takes effect January 1, 2027 and covers many GLP-1, hormone and IV clinics.
How to Price the Management Fee
The Board's rules bar a practitioner from sharing a professional fee with another practitioner unless that person is a partner, employee or professional corporation shareholder, or unless the patient consents and the division is proportional to services performed and responsibility assumed. They also say a practitioner shall not pay, demand or receive compensation for referring a patient. We found no Indiana authority on percentage fees, so Indiana should not be treated as having approved them, and we use a fixed fee.
What the Practice Must Keep
Under Iterman and the practice act, a management company may not direct clinical judgment, and corporate-form labels do not cure control in substance. The registered responsible practitioner must have prescriptive authority and training, be physically present for a sufficient amount of time and ensure each worker is licensed and trained.
Terms to Avoid
Avoid referral-based pay, any term letting the management company direct diagnosis or treatment, and a responsible practitioner who is not actually present.
Term, Records and Departing Clinicians
A 2025 law bans non-competes between physicians and hospitals and hospital systems and likely does not reach a cash-pay practice. The practice keeps clinical records.
Filings, Notices and Watch Items
Indiana requires 90 days' written notice to the Attorney General of certain mergers and acquisitions among health care entities when combined assets reach $10 million, and a 2025 law added an exclusion for providers majority-owned by Indiana-licensed practitioners and ownership reporting to the Secretary of State starting January 1, 2026 for owners with 5% or more. We could not confirm whether a management agreement without equity counts or whether a cash-pay practice is within the reporting exclusion. Senate Enrolled Act 282 requires med spa registration from January 1, 2027, with serious adverse event reports within 15 days.
Drafting Checklist
- Fee: fixed, no referral compensation.
- Fee sharing: only with partners, employees and shareholders.
- Control: no direction of diagnosis or treatment.
- Registration: med spa registration from January 1, 2027 where the definition applies.
- Notice: check the $10 million asset trigger and ownership reporting.
How We Draft It
Patients pay the physician-owned practice, the practice pays the management company a fixed monthly fee under the agreement, and the management company pays MedGrid a fixed monthly retainer for consulting. The management company never practices medicine, and the agreement never moves a clinical decision to it. Our template follows the same flat-fee design in every state, with the state-specific limits below layered on top.
Disclaimer
This article is general educational information, not legal advice. Management agreement rules change and differ by state, and this summary draws on our published state guide, parts of which rest on secondary sources, so have health care counsel in the state review any agreement before you sign.
MedGrid MSO provides management services to independently owned practices; it does not practise medicine and does not direct clinical decisions. Requirements vary by state and by service, and change over time — nothing on this page is legal or medical advice. Talk to us or your own counsel before making a structural decision for your clinic.